This chapter discusses the management of intensive care unit (ICU) patient in the emergency department. Frequent reassessment of ICU boarders is essential. Since mortality starts to increase at about 6 hours, it is reasonable to completely reassess an ICU boarder every 2-4 hours. Assessments should focus on fundamentals of care and disease-specific goals. Volume status is a critical component of resuscitation and management. Accurate "Ins and Outs" are frequently poorly recorded in ICU boarders. This can be remedied by asking the nurses to never take down an empty IV bag, and to number each IV bag with a permanent marker prior to administration. The ICU is completely responsible for patient care, orders, and management. The emergency physician is available for emergent interventions and acute deterioration while the patient is in the emergency department (ED). Shared responsibility of care is often dictated by a consensus interdepartmental policy.